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General NPI Number Information
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NPI Number | 1417467010
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Entity Type | Individual
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Provider Name | ROBERT JOHNSON NP
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Gender | Male
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Dates
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Enumeration Date | 10/09/2017
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Last Update Date | 07/21/2020
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Provider Practice Location Address
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Address Line | 104 HARDIN LN STE A
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City | SOMERSET
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State | KY
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Zip | 42503
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Country | US
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Telephone | 606-678-8323
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Fax | 606-678-0496
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Provider Business Mailing Address
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Address Line | 104 HARDIN LN STE A
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City | SOMERSET
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State | KY
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Zip | 42503-3800
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Country | US
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Telephone | 606-678-8323
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Fax | 606-451-0963
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 3011600
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 3011600
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License Number State | KY
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